The treatment of ovarian stimulation that is performed prior to performing an in vitro fertilization (IVF) to obtain a high number of oocytes is indispensable to achieve a good gestation prognosis, since it allows to have a better control of the cycle than when No medication is taken, setting at the right time on the day of the follicular aspiration and being certain that most oocytes will be mature.
In addition, the endometrium (mucosa of the inside of the uterus) becomes much more receptive and, since there are more oocytes (without treatment there would be only one), the best embryos can be selected to transfer them.
However, like any medical treatment, in vitro fertilization is not free of adverse effects, which may occur occasionally. Fortunately, these are occasional and not generalized at all. Specialists in Assisted Reproduction accompany their patients throughout the process. The medication is personalized for each patient, which allows to achieve the desired response and also avoid side effects. Also, the professionals carry out monitoring and monitoring from transvaginal ultrasounds, which allow early identification of any unwanted effects.
Ovarian hyperstimulation syndrome in IVF processes
Ovarian hyperstimulation syndrome is one of the possible side effects of in vitro fertilization. The ovarian response is usually more or less the same, developing an average of 10-12 follicles but, exceptionally, the ovaries may react exaggeratedly, being able to produce what is known as ovarian hyperstimulation syndrome (OHSS). This syndrome is very rare: its incidence is 0.5-10% of cases. Severe OHSS cases have an incidence of between 0.5% and 1% only.
Ovarian hyperstimulation syndrome is characterized by the presence of a large number of follicles that are seen by ultrasound within a few days of administering the medication to the patient. In addition, these patients have a very high amount of estrogen.
Treatment of ovarian hyperstimulation syndrome
If the response of the ovaries is observed soon it is easy to prevent the development of severe hyperstimulation, since nowadays it is known that the syndrome is triggered by the hormone hCG, which is the one that is applied to cause ovulation. In these cases, the administration of hCG is canceled out and the follicles are spontaneously reabsorbing to start a new cycle the following month.
Another option not to miss the cycle is the triggering of ovulation with a dose of gonadotropin releasing hormone (GnRHa), which causes a peak of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The function of these hormonal changes is, in short, the recovery of these oocytes for their fertilization and vitrification for their transfer in another cycle. With the hormone GnRHa a faster recovery of the ovary is achieved until it reaches its natural state, which minimizes the risk.
However, although ovarian hyperstimulation is very rare, it is important that the patient is informed of the possibility of its occurrence.
Ascites or accumulation of plasma in the abdominal cavity
In other cases, the response is normal at the onset and the syndrome is triggered when hCG has already been given because of the impossibility of predicting hyperstimulation. The patient, a few days after the aspiration of the eggs, presents abdominal distension and discomfort in the ovaries.
This is because hyperstimulation causes part of the blood (plasma) fluid to flow out of the arteries and into the abdominal cavity. If there is a high amount of fluid, which can sometimes exceed 3 liters of fluid in the abdomen, there is an annoying ascites that compresses the intestinal loops, making digestion difficult.
The ovaries present an increase in size and float in the fluid so that, when moving, the patient notices more discomfort. Since there is little fluid in the blood, you urinate less often. Thanks to infertility specialists who administer the medication, these symptoms are quickly detected and treated to eliminate discomfort.
Treatment of ascites is symptomatic. To avoid the formation of clots, the patient must be very hydrated, so it is advised to take more than three liters of fluid a day and preferably isotonic drinks, since these decrease the plasma output of blood. In the most serious cases, it will be essential for the patient to enter for intravenous administration of serum, also adding anticoagulants. Analgesics and rest are also recommended so that the ovaries move as little as possible.
The process resolves on its own after 8-10 days. Extraordinarily, if ascites is very important, it may require emptying the abdominal fluid to decrease distension, which rapidly improves the condition.
At other times, hyperstimulation has an insidious onset and then becomes difficult. This usually happens when the woman becomes pregnant, since the hyperstimulation is triggered by the hCG hormone, which is precisely the one that generates the small placenta of the embryo from the first moment that implants in the maternal uterus.
Since ovarian hyperstimulation syndrome is a very rare process, the main thing is to try to prevent it by serial controls of estradiol in the blood and the ultrasounds that are realized along the treatment for the IVF.